Distal Femur Resection With Endoprosthetic Reconstruction

Bickels, Jacob; Wittig, James C.; Kollender, Yehuda; Henshaw, Robert M.; Kellar-Graney, Kristen; Meller, I.; Malawer, Martin M.

doi:10.1097/00003086-200207000-00028

Cited by 192 publications

(178 citation statements)

References 20 publications

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“…Although endoprosthetic reconstruction is a well-accepted method for treatment of primary bone tumors of the distal femur, the long-term survival of these implants varies from 67% to 90% at 5 years [22]. The complications for this reconstruction option are aseptic loosening (3%-40%), infection (3%-28%), and mechanical wear/prosthetic or component fracture (1%-67%) [2,6,8,12,13,15,19,27,30,33]. Intercalary allografts offer a joint-sparing reconstructive option, but nonunion, delayed union, infection, and graft fractures are well-described complications [20,21,23,24].…”

Section: Introductionmentioning

confidence: 99%

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Zimel¹,

Cizik

Rapp³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Although functionally appealing in preserving the native knee, the condyle-sparing intercalary allograft of the distal femur may be associated with a higher risk of tumor recurrence and endoprosthetic replacement for malignant distal femoral bone tumors. We therefore compared the risk of local tumor recurrence between patients in these two types of reconstruction groups. We retrospectively reviewed 85 patients (mean age, 22 years; range, 4-82 years), 38 (45%) of whom had a condyle-sparing allograft and 47 (55%) of whom had endoprostheses. The minimum followup for both groups was 2 years (mean, 7 years; range, 2-19 years). Local recurrences occurred in 11% (five of 47) of the patients having implants versus 18% (seven of 38) of the patients having allografts. Using time to local recurrence as an end point, the Kaplan-Meier

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Section: Introductionmentioning

confidence: 99%

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Zimel¹,

Cizik

Rapp³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…Moreover, possible multiple revision surgeries with limited bone stock is another difficult problem. Although high survival rates have been reported with this type of reconstruction [4,14], complication and failure rates also have been high in other series [3,10]. Henderson et al [13] reviewed 534 endoprosthetic failures from five institutions.…”

Section: Discussionmentioning

confidence: 99%

“…Owing to requirements for stability, motion, and function, reconstructing this joint has been demanding. Available options have included endoprostheses [3,4,10], bicondylar osteoarticular allografts [12,23], and unicondylar osteoarticular allografts [2,17,18]. Endoprostheses can provide immediate fixation and rapid return to weightbearing, but they are associated with major complications including aseptic loosening (6%-84% at 5 to 10 years), infection (7%-41%), and periprosthetic fracture (5%-15%) [13,14].…”

Section: Introductionmentioning

confidence: 99%

Surgical Technique: Unicondylar Osteoallograft Prosthesis Composite in Tumor Limb Salvage Surgery

Guo

Wang

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background After resecting tumors confined to one femoral condyle, a unicondylar osteoarticular allograft can be used for reconstruction without sacrificing the uninvolved condyle. However, unicondylar osteoarticular allografts have been associated with a high rate of joint degeneration. We describe a unicondylar osteoallograft prosthesis composite reconstruction replacing only one side of the joint to reduce compartment degeneration and avoid contamination of the tibia, but the survival, function, and complications of a unicondylar osteoallograft prosthesis composite are unclear. Description of Technique We located a bone resection plane intraoperatively as planned before surgery using a computer-assisted navigation system. The tumor then was removed en bloc and the unicondylar defect filled with a size-matched allogeneic unicondyle. The allograft cartilage was removed. Thereafter, the condyle of the femoral component was resurfaced with a unicompartmental knee prosthesis to form a unicondylar osteoallograft prosthesis composite, however the tibia was left undisturbed. Navigation allowed precise apposition between the unicondylar osteoallograft prosthesis composite and host bone to ensure mechanical alignment and congruency of the joint surface before fixation with a plate. Methods We retrospectively reviewed 12 patients who underwent unicondylar osteoallograft prosthesis composite reconstructions after unicondylar resection for tumors. One patient died from tumor-related causes without unicondylar osteoallograft prosthesis composite failure after 18 months. We observed the survival rate of unicondylar osteoallograft prosthesis composite reconstruction and related complications. Function and radiographs also were documented according to the Musculoskeletal Tumor Society (MSTS) functional scoring system and the International Society of Limb Salvage radiographic scoring system. The minimum followup was 8 months (median, 37 months; range, 8-65 months). Results At last followup, 10 of the 12 unicondylar osteoallograft prosthesis composite reconstructions were still in place. Three reconstructions failed owing to two local recurrences (both treated with amputation) and there was one infection (treated with revision and maintenance of the implant at last followup). The average MSTS functional score at last followup was 27 points and the radiographic score 91%. Conclusions Our observations suggest unicondylar osteoallograft prosthesis composite reconstruction might be a reliable technique with relatively few major complications and at least short-term maintenance of the tibial cartilage.

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“…We found several surveys with a low level of evidence (evidence level III or IV). [1][2][3][4][5]8,10,11,20,21,[22][23][24][25] This reflects the challenge and the difficulty involved in clinical surveys on orthopedic oncology.…”

Section: Discussionmentioning

confidence: 99%

Complicações das endopróteses em pacientes com tumores ósseos do joelho

et al. 2011

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Non-conventional endoprostheses (NCE) are frequently used in orthopedic oncology. The complications associated with this procedure have prompted research, due to the fact that it is commonly performed on young patients, with a higher survival rate. We conducted a systematic review of the literature, searching for the best scientific evidence on the subject. The research was carried out in the following databases: MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of randomized controlled trials (CCTR), seeking to identify studies that report complications, and compare patellar resurfacing versus retention. The studies were selected according to the Article received on 9/5/09 and approved on 5/27/10 best methodological quality that exists for the subject. One hundred and forty six (146) studies were evaluated. No randomized clinical trial was found. We conducted a qualitative and quantitative evaluation of the work found (evidence levels IV and V). We used the Mann-Whitney U test for the statistical analysis. The results indicate a need for further studies that will enable us to reach a more solid conclusion. The rate of complications after NCE can be considered high, despite the low quality of the studies, as demonstrated by the studies that exist in the literature.

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Distal Femur Resection With Endoprosthetic Reconstruction

Cited by 192 publications

References 20 publications

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Surgical Technique: Unicondylar Osteoallograft Prosthesis Composite in Tumor Limb Salvage Surgery

Complicações das endopróteses em pacientes com tumores ósseos do joelho

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